Vol. 9, No. 42005 Abstracts 613

mucous cystoplasm. The cyst wall demonstrated areas of hyaline col-lagenous thickening, focal calcification and subepithelial foci resem-bling ovarian stroma with parallel-orientated wavy fibroblasts. Therewere areas of metaplasia but no dysplasia or frank malignancy. Themargins of resectionwere uninvolved. Immunohistochemistry demon-strated positive staining of the stromal cells for vimentin, estrogen andprogesterone receptors. This case demonstrates that mucinous cysta-denoma with ovarian-like stroma can occur in males.

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SYNCHRONOUS SEROUS CYSTADENOMA ANDPANCREATIC ENDOCRINE TUMOR: A CASE REPORTAND LITERATURE REVIEWBrian K. Goh, Yu Meng Tan, Priyanthi Kumarasinghe, LondonLucienOoi, Singapore General Hospital, Singapore; National CancerCentre, Singapore

The coexistence of serous cystic tumors and islet cell tumors in thepancreas are extremely rare andmay occur independently or combinedwithin the same tumormass.We report a case of a 52-year-oldChinesemale with synchronous serous cystadenoma in the head of pancreasand pancreatic endocrine tumor (PET) in the tail. To the best of ourknowledge, this is the first reported case in the English literatureof synchronous serous cystic tumor and pancreatic tumor occurringseparately and also only the second reported case of coexistent serousand endocrine tumor of the pancreas occurring in a male patient.This is a case report. A 52-year-old Chinese male was found inciden-tally to have a 14-mm hypoechoic nodule in the head of pancreasduring screeningUS. The patient was asymptomatic and had no familyhistory of von Hippel-Lindau syndrome. CT and MRI confirmed thepresence of a 1.5 × 1.0 cm hypervascular mass in the ventral aspectof the head of pancreas suggestive of a PET. All the laboratory investi-gations including the serum concentrations of insulin, glucose, insulin/glucose ratio, C-peptide, calcium, phosphate, parathyroid hormoneand 24-hour urinary metanephrine and normetanephrine excretionrates were within normal limits thus excluding the presence of insu-linoma, phaeochromocytoma or hyperparathyroidism. The liver func-tion tests and tumor markers including carbohydrate 19-9,carcinoembryonic antigen and alphafetoprotein levels were also withinnormal limits. The patient underwent exploratory laparotomy duringwhich a 2-cm cystic mass was found encroaching the head of thepancreas. Subtotal pancreatectomy with splenectomy was performedand the patient’s postoperative recovery was uneventful. Final histol-ogy revealed a 1.5-cm serous microcystic adenoma in the head ofpancreas and an incidental 0.3-cm benign nonfunctioning glucago-noma at the tail. At a follow-up of 2 years, the patient remainedwell and disease-free. This case emphasizes the importance of carefulintraoperative examination for the occurrence of synchronous tumorsduring surgical resection of pancreatic tumors. The use of intraopera-tive ultrasound routinely may be helpful in detecting small synchro-nous tumors which may be difficult to detect via gross palpation. Italso illustrates the importance of a thorough pathological examinationand sampling of pancreatic tumors as grossly apparent benign pancre-atic tumors may coexist and draw attention away from a synchronousneoplasm with malignant potential.

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ZOLLINGER-ELLISON SYNDROME WITHSYNCHRONOUS ADENOCARCINOMA OF THEPANCREAS: A CASE REPORTHollie J. Hickman, DO, Timothy M. Schmitt, MD, Justin Nguyen,MD, Mayo Clinic, Jacksonville, FL

We report a rare case of a patient presenting with Zollinger-Ellisonsyndrome and an incidental finding of a synchronous pancreatic adeno-carcinoma. A positive secretin stimulation test confirmed the diagnosisof Zollinger-Ellison syndrome. Localization studies including CT,MRI and endoscopic ultrasound revealed a pancreatic mass. Pancreat-icoduodenectomy revealed severely scared and inflamed duodenumwith a 3 × 3 cm pancreatic adenocarcinoma and a 2-mm duodenalgastrinoma with collision metastasis of both tumors in peripancreaticlymph nodes. To our knowledge, this is the first case report describinga primary gastrinoma with an incidental finding of a synchronouspancreatic adenocarcinma with a collision metastatic lymph node.

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PREVENTION AGAINST LIVER METASTASISBY COMBINATION OF GEMCITABINE ANDWHOLE LIVER IRRADIATION AFTER PANCREATICCANCER SURGERYYoshito Ikematsu, MD, PhD, Hiroaki Kuroda, MD, PhD, HirokiMoriuchi,MD, PhD, KeigoGoto,MD,Takao Yamamoto,MD, PhD,Yoshiro Nishiwaki, MD, PhD, Hideo Kida, MD, PhD, Shinji Waki,MD, PhD, Hamamatsu Medical Center, Hamamatsu, Japan

The recurrence sites after pancreatic cancer excision are mainly local,peritoneum and liver. Extended operation and/or intraoperative irra-diation are performed for the prevention of local or peritoneum recur-rence. On the other hand, an effective prevention for metastases tothe liver is not obscure. Radiation to the whole liver with simultaneous5-FU IV administration, which is a radiation sensitizer, is an ongoingtrial to kill minute liver metastasis, which is not visualized by CT orMRI at surgery (personal communication). Gemcitabine hydrochlo-ride (GEM), which is also a radiation sensitizer, is utilized for patientswith advanced pancreatic cancer in Japan since April 2001. We willreport the effect of whole liver irradiation and simultaneous GEMadministration comparing with those without GEM, retrospectively.Twenty-three patients with pancreatic cancer were operated to datesince August 2001. Eight cases were withdrawn from the study (un-resectable: 2, declined to participate: 1, death within 30-day: 1). GEM(1000 mg/body/wk × 3 wks) was given to the remaining 15 patientsstarting from two weeks after the curative intended surgery, and wholeliver irradiation (2 × 10 Gy) was performed simultaneously. GEM(400-600 mg/body/2 wk) was continued as longer as possible afterdischarge fromhospital (GroupA). Sixty-one patients undergone cura-tive operation before 2001 (Group B) were compared as control onpatients’ background, survival, and liver metastases rate, retrospec-tively. Survival rates in Group A (100% at 1-year and 58% at 2-year)were significantly higher than that in Group B. (65% at 1-year and58% at 2-year; P � 0.034). Two of 3 patients died in Group Adeveloped liver metastases. On the other hand, 30% of the patientsin Group B. were confirmed to have liver metastases at the time ofdeath. Simultaneous administration of GEM and whole liver irradia-tion improved survival rate after pancreas cancer surgery.

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THE IMPACT OF SURGICAL COMPLICATIONS ONSURVIVAL OF PATIENTS WITH HPB MALIGNANCIESRezaF. Saidi,MD,GelenDelRosario,MD,PhD, StephenG.Remine,MD, Michael J. Jacobs, Providence Hospital and Medical Centers,Southfield, MI

There are numerous prognostic factors that affect surgical outcomefor patients with hepato-pancreato-biliary (HPB) malignancies. Theimpact of surgical complications, however, has not been adequatelystudied. Herein, we describe the impact of postsurgical complications